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/ ^Oib?o-o^ <br />/y^Rev. 4/6' <br />PART B <br />\ <br />\ <br />If the <br />TBE\rer <br />lECT <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Owner <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />Con tractor J^On U 3. /jJcJ/ <br />tu_____ <br />CITY PERMIT NO.8386 <br />Date <br />Address ^ <br />Address <br />State License No. <br />1 . <br />‘ ! <br />t - <br />M / <br />/ <br />.. / <br />name) <br />I Code) <br />on t>eck) <br />PERMIT TYPE AND FEE: <br />Inside Plumbing (^fixtures __ <br />iCB NEW □ ADDITION □ REPAIR <br />.) <br />Water Meter (Size <br />Meter#___ <br />-) <br />Remote #. <br />Municipal Water Connection <br />n Copper Q___ <br />Municipal Sewer Connection <br />□ pVC Ocast a <br />MWee SAC Charge <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Th» undw«lyi«d benby acknowledgas netipt of tbls limited <br />I^U, inclutog •eceptane* of aU ipoclal Infonnation. <br />tem^ eondtttona op toquiRments wdtteii above. Tba <br />•nd agreea under penalty of law <br />that tbla petmlt la atrictly limited in acopa to tbe '.rork <br />•^Wty or improvement apeelfied: that tbU permit docs' <br />not grant any autbority to do work or activities requiring <br />!!?"•*• •PPPOvals; and that this permit does not <br />gmt authority to vioUte any provision of any City <br />ordinme or State law, rule or regulaUon. All work ahall be <br />done in strict compliance with all City ordlnaneas, building <br />coin and/or health department teguUttons, and shall be <br />^lect to inspection, approval or rejection by the City <br />Whenever so ordered, the undersigned agrees to correct <br />^pemit.*****"'* vloUtion of the condiUons of <br />Signature of Appli^an*.^^ ^ ^ <br />----------------------------------------- <br />Fee S Water Well Fee $ <br />Fee S Mechanical Equipment Fee $ <br />Moving /Lifting Buildings Fee $ <br />Fee S Land Alteration (Excavation,Fee SGrading, FUling, etc.) <br />Fee $Fire _Pee S <br />Sprinkler System (Fire)Fee $ <br />Fee S Other:Caa C <br />Fee S After-the-fact Investigation Fee $ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S 3^. <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />Code: White-1 Ue Copy Canary-Inspcctor’s Copy Pink-Financc Copy Gold-Applicant’s Receipt